Healthcare Provider Details

I. General information

NPI: 1477985737
Provider Name (Legal Business Name): SANDRA DEE BUNN CNS-PP, ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 SHORELINE DR N
KEIZER OR
97303-5829
US

IV. Provider business mailing address

890 OAK ST SE BLDG B PO BOX 14001
SALEM OR
97301-3905
US

V. Phone/Fax

Practice location:
  • Phone: 801-648-3824
  • Fax:
Mailing address:
  • Phone: 503-561-1543
  • Fax: 503-561-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number201390180CNS-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: